fsrh-ukmec-full-book-2019.pdf

UK MEDICAL ELIGIBILITY CRITERIA
FOR CONTRACEPTIVE USE | UKMEC 2016
(AMENDED SEPTEMBER 2019)

FSRH provided funding to the Clinical Effectiveness Unit (of the FSRH)
to assist them in the production of this guidance, the UK Medical Eligibility for Contraceptive Use (2016).
Published by the Faculty of Sexual and Reproductive Healthcare
Registered in England No. 2804213 and Registered Charity No. 1019969
UKMEC first published in July 2006
Copyright © Faculty of Sexual and Reproductive Healthcare 2006 to 18 May 2016.
This document is also available digitally on our website at www.fsrh.org
Permission is granted to reproduce or transmit this document for non-commercial personal and
non-commercial education use only. Commercial use of any kind, including copying,
hiring and lending, is prohibited.
Any reproduction of the whole of this document must reproduce this copyright notice in its entirety.
Any reproduction of a part of this document must include a statement that it is reproduced under licence
from FSRH and the notice Copyright ©Faculty of Sexual and Reproductive Healthcare 2006 to 2016.
Published in the UK

Details of changes to original document
Since this document was first published, the following changes have been made:
December 2017
The UKMEC category for use of progestogen-only injectable contraception by women at high risk of
acquiring HIV has been revised from UKMEC2 (benefits of use generally outweigh risks) to UKMEC1
(no restrictions to use).
September 2019
The UKMEC category for use of progestogen-only injectable contraception and intrauterine
contraception by women at high risk of acquiring HIV has been revised from UKMEC2 (benefits of use
generally outweigh risks) to UKMEC1 (no restrictions to use).
Additional Resource: Diagnosis of Migraine With or Without Aura has been updated to signpost
directly to the International Headache Society's International Classification of Headache Disorders
(3rd edition).

00 Copyright ©Faculty of Sexual and Reproductive Healthcare 2006 to 2016.
SECTION A: INTRODUCTION
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)........................................ 01
Development of the UKMEC.....................................................................................................01
Using the UKMEC.....................................................................................................................02
Contraceptive Choice................................................................................................................04
Effectiveness of Contraceptive Method.....................................................................................04
Drug Interactions with Hormonal Contraception........................................................................05
Conditions that May Pose a Significant Health Risk During Pregnancy....................................06
Summary of Changes from UKMEC 2009.................................................................................07

01
Copyright ©Faculty of Sexual and Reproductive Healthcare 2006 to 2016.
The UK medical eligibility criteria for contraceptive use (UKMEC)
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) offers guidance to providers
of contraception regarding who can use contraceptive methods safely. These evidence-based
recommendations do not indicate a best method for a woman nor do they take into account
efficacy (and this includes drug interactions or malabsorption). The recommendations allow for
consideration of the possible methods that could be used safely by individuals with certain health
conditions (e.g. hypertension) or characteristics (e.g. age) to prevent an unintended pregnancy.
Most contraceptive users are medically fit and can use any available contraceptive method
safely. However, some medical conditions are associated with potential or theoretical increased
health risks when certain contraceptive methods are used, either because the method
adversely affects the condition or because the condition or its treatment affects the safety of
the contraceptive. Since most trials of new contraceptive methods deliberately exclude subjects
with chronic medical conditions, there is often little direct evidence on which to base accurate
prescribing advice.
Development of the UKMEC
The World Health Organization (WHO) developed a set of internationally agreed norms for
providing contraception to individuals with a range of medical conditions that may contraindicate
one or more contraceptive methods. The first edition of the WHO Medical Eligibility Criteria
for Contraceptive Use (WHOMEC) was published in 1996. The fifth edition was published in
2015 and is available on the WHO website.1
The WHOMEC is primarily intended for use in
developing countries where the risks associated with pregnancy are often extremely high but it
is the intention of WHO that the guidance be adapted for use in different settings in which the
risk benefit ratio of contraceptive methods may differ.
The first edition of the UKMEC was published in 2006 with a grant from the Department of Health
(England).The document was widely distributed to clinicians throughout the United Kingdom
(UK) with funding from the Department of Health (England), the Scottish Executive (Scotland)
and the Faculty of Sexual and Reproductive Healthcare (FSRH). The second edition of the
UKMEC2
was published in 2009. UKMEC 2016 supersedes the second version and has taken
account of new evidence included in the WHOMEC (fifth edition).
The UKMEC update was led by the Clinical Effectiveness Unit (CEU) of the FSRH and involved a
guideline development group (GDG) consisting of 19 members (see Appendix 1 for the UKMEC
development process and Appendix 2 for the list of contributors). A formal consensus process3
was used by the GDG with the aim of making the best use of published evidence and capturing
the collective knowledge of experts in the fields of sexual and reproductive health and allied
specialties to inform the recommendations included in the UKMEC classifications. The changes
in UKMEC 2016 from UKMEC 2009 are summarised and highlighted at the end of Section A.

USING THE UKMEC
The UKMEC considers the following groups of contraceptive methods: intrauterine contraception
(IUC), progestogen-only contraception (POC), combined hormonal contraception (CHC) and
emergency contraception (EC). The UKMEC categories for each of these groups can be found
in Section B, together with evidence summaries and clarifications. Additional comments can be
found at the end of each method section. References and additional resources are located in
Section C. Commonly used abbreviations are listed in Appendix 3.
The UKMEC Categories
For each of the personal characteristics or medical conditions considered by the UKMEC a
Category 1, 2, 3 or 4 is given. The definitions of the categories are given in Table 1.
Table 1: Definition of UKMEC categories
UKMEC DEFINITION OF CATEGORY
Category 1 A condition for which there is no restriction for the use of the method
Category 2
A condition where the advantages of using the method generally outweigh the
theoretical or proven risks
Category 3
A condition where the theoretical or proven risks usually outweigh the
advantages of using the method. The provision of a method requires expert
clinical judgement and/or referral to a specialist contraceptive provider, since
use of the method is not usually recommended unless other more appropriate
methods are not available or not acceptable
Category 4 A condition which represents an unacceptable health risk if the method is used
When applied in a clinical setting, a UKMEC Category 1 indicates that there is no restriction for
use. A UKMEC Category 2 indicates that the method can generally be used, but more careful
follow-up may be required. A contraceptive method with a UKMEC Category 3 can be used;
however, it may require expert clinical judgement and/or referral to a specialist contraception
provider since use is not usually recommended unless other methods are not available or
acceptable. A UKMEC Category 4 indicates that use in that condition poses an unacceptable
health risk and should not be used.
Initiation and Continuation of a Method
The initiation (I) and continuation (C) of a method of contraception can sometimes be distinguished
and classified differently (see Table 2). The duration of use of a method of contraception prior to
the new onset of a medical condition may influence decisions regarding continued use. However,
there is no set duration and clinical judgement will be required.

03
Table 2: Initiation and continuation of a method by women with a medical condition
Initiation (I) Starting a method by a woman with a specific medical condition.
Continuation (C)
Continuing with the method already being used by a woman who develops
a new medical condition.
For example, the initiation of a progestogen-only pill (POP) is not restricted in a woman with stroke
(cerebrovascular accident) as the advantages of using the method generally outweigh the theoretical
or proven risks (UKMEC 2). However, if a woman has a stroke (cerebrovascular accident) while
using a POP, the continuation of the method will require expert clinical judgement and/or referral to
a specialist contraceptive provider because use of that method is not usually recommended unless
other, more appropriate methods are not available or acceptable (UKMEC 3).
Using the UKMEC Tables
The UKMEC tables are set out as follows (from left to right, see Table 3):
•
The first column indicates the CONDITION. Each condition is defined as representing either
an individual’s characteristics (e.g. age, parity) or a known pre-existing medical condition (e.g.
diabetes, hypertension). Some conditions are subdivided to differentiate between varying
degrees of the condition (e.g. migraine with or without aura).
• The CATEGORY (UKMEC 1 to 4) for each CONDITION is given for each method of
contraception. Occasionally, NA (not applicable) is used, which denotes a condition for which
a ranking was not given but for which clarifications have been provided.
•
The last column is used to provide CLARIFICATION or to make comment on the EVIDENCE
for the recommendation where appropriate.
Table 3: Example of tables in UKMEC
METHOD OF CONTRACEPTION
CONDITION CATEGORY
I = Initiation,
C = Continuation
CLARIFICATION/EVIDENCE
Obesity Category 1, 2, 3 or 4
Clarifications and evidence regarding
the condition or classification

It is important to note that the UKMEC categories:
•
Relate to the SAFETY of use of a method of contraception by a woman with a particular
medical condition or personal characteristic. The EFFICACY of contraception may be affected
by the condition or by a medication required for the condition but the UKMEC category does
not reflect this.
•
Are intended to be applied to use of the method of contraception for contraceptive purposes.
Where a method of contraception is used for a non-contraceptive indication [e.g. management
of heavy menstrual bleeding (HMB)] the risk/benefit profile and eligibility criteria may differ.
•
Cannot simply be added together to indicate the safety of using a method. For example, if
a woman has two conditions that are each UKMEC 2 for use of CHC, these should not be
added to make a UKMEC 4. However, if multiple UKMEC 2 conditions are present that all
relate to the same risk, clinical judgement must be used to decide whether the risks of using
the method may outweigh the benefits. For example, consider a 34-year-old woman wishing
to use CHC who has a body mass index (BMI) of 34 kg/m2
(UKMEC 2), is a current smoker
(UKMEC 2), has a history of superficial venous thrombosis (UKMEC 2), and has a first-degree
relative who had a venous thromboembolic event at age 50 years (UKMEC 2), all potential
risk factors for venous thromboembolism (VTE). She might be better advised to consider a
different method of contraception that does not increase her risk of VTE. When an individual
has multiple conditions all scoring UKMEC 3 for a method, use of this method may pose an
unacceptable risk; clinical judgement should be used in each individual case.
Contraceptive Choice
Many factors determine the method of contraception an individual chooses to use. Provided
the woman is medically eligible to use a particular method, she should be free to choose the
method that is most acceptable to her. To be effective, contraception must be used correctly and
consistently. Effective and continued use of a method is directly related to its acceptability to the
user.
Women should be given accurate information about all methods for which they are medically
eligible and helped to decide which might best suit their needs. Health professionals who give
advice about contraception should be competent to give information about the efficacy, risks
and side effects, advantages and disadvantages, and non-contraceptive benefits of all available
methods.
Information on contraception for women in the UK can be found on the Family Planning
Association (fpa) website.4
Effectiveness of Contraceptive Method
Methods that require consistent and correct use by individuals have a wide range of effectiveness
and can vary greatly with characteristics such as age, socioeconomic status, users’ desires to
prevent or delay pregnancy, and culture.Table 4 compares the percentage of women experiencing
an unintended pregnancy during the first year of contraceptive use when the method is used
‘typically’(which includes both incorrect and inconsistent use) or ‘perfectly’(correct and consistent
use).5
Methods considered as long-acting reversible contraception (LARC) are highlighted in
Table 4.

05
Table 4: Percentage of women experiencing an unintended pregnancy within the first
year of use with typical use and perfect use (modified from Trussell et al.)5
Method Typical use (%) Perfect use (%)
No method 85 85
Fertility awareness-based methods 24 0.4–5
Female diaphragm 12 6
Male condom 18 2
Combined hormonal contraception (CHC)* 9 0.3
Progestogen-only pill (POP) 9 0.3
Progestogen-only injectable (DMPA) 6 0.2
Copper-bearing intrauterine device (Cu-IUD) 0.8 0.6
Levonorgestrel-releasing intrauterine system (LNG-
IUS)
0.2 0.2
Progestogen-only implant (IMP) 0.05 0.05
Female sterilisation 0.5 0.5
Vasectomy 0.15 0.1
*Includes combined oral contraception (COC), transdermal patch (patch) and vaginal rings.
A pictorial chart on the effectiveness of family planning methods is available from the Centers
for Disease Control and Prevention (CDC) website.6
Drug Interactions with Hormonal Contraception
Use of other medications may increase or decrease serum levels of contraceptive hormones;
likewise, hormonal contraception may increase or decrease serum levels of other medications.
This can potentially cause adverse effects. Health professionals providing hormonal
contraception should ask women about their current and previous drug use including
prescription, over-the-counter, herbal, recreational drugs, and dietary supplements. Women
should be advised to use the most effective methods for them; this may include the additional
use of non-hormonal barrier methods when potential drug interactions pose concern.
For further guidance and resources regarding specific contraceptive method/formulation,
please refer to
•
FSRH guidance on drug interactions with hormonal contraception,7
available on the
FSRH website
• The British National Formulary (BNF) publications and website.8
•
Summary of product characteristics (SPC), available on electronic Medicine Compendium
(eMC) website.9

Online Drug Interaction Checkers
There are online drug interaction checkers available which give useful information on drug
interactions. For up-to-date information on the potential drug interactions between hormonal
contraception and antiretroviral (ARV) drugs, please refer to the online HIV drugs interaction
checker.10
For up-to-date information on the potential drug interactions between hormonal contraception
and other drugs, please refer to Stockley's Drug Interactions website.11
Please note that the contraceptive effectiveness of DMPA and the LNG-IUS is not reduces by
concurrent use of enzyme-inducing medications.
If in doubt please refer to the current FSRH Guideline on Drug Interactions with Hormonal
Contraception.7
Conditions that May Pose a Significant Health Risk During Pregnancy
Women with conditions that may pose a significant health risk during pregnancy should be
advised to consider using the most effective LARC methods, which provide a highly reliable
and effective method of contraception (failure rate 1 pregnancy per 100 women in a year).
The sole use of barrier methods and user-dependent methods of contraception (e.g. oral
contraception) may not be the most appropriate choice for these women given their relatively
higher typical-use failure rates.
Some conditions that expose a woman to increased risk as a result of unintended pregnancy
include but are not limited to:
• Bariatric surgery within the past 2 years
• Breast cancer
• Cardiomyopathy
• Complicated valvular heart disease
• Cystic fibrosis
• Diabetes: insulin-dependent, or with
nephropathy/retinopathy/neuropathy or
other vascular disease
• Endometrial or ovarian cancer
• Epilepsy
• Gestational trophoblastic neoplasia
• HIV-related diseases
• Hypertension (systolic 160 mmHg or
diastolic 100 mmHg)
• Ischaemic heart disease
• Malignant liver tumours (hepatocellular
carcinoma)
• Morbid obesity (BMI ≥40 kg/m2
)
• Organ failure/transplant
• Rheumatoid arthritis
• Severe (decompensated) cirrhosis
• Sickle cell disease
• Stroke
• Systemic lupus erythematosus (SLE)
• Systemic sclerosis
• Thrombogenic conditions
• Tuberculosis
• Teratogenic drugs (see below)

07
Women using teratogenic drugs (e.g. methotrexate, some anti-epileptic drugs and retinoids)
or drugs with potential teratogenic effects should also be advised to use reliable and effective
contraception both during treatment and for the recommended timeframe after discontinuation to
avoid unintended pregnancies. More information is available from the UK Teratology Information
Service (UKTIS) website.12
Summary of Changes from UKMEC 2009
A total of 27 topics and more than 126 recommendations were reviewed as part of the UKMEC
revision. Changes from UKMEC 2009 include the exclusion of some methods and conditions,
inclusion of new conditions and ulipristal acetate (UPA) as a new method of EC, removal of
split UKMEC categories, revision of sub-conditions and the reordering of the contraceptive
methods in the UKMEC tables.
Method Sections No Longer Included
Comprehensive, method-specific FSRH guidance on barrier methods for contraception and
sexually transmitted infection (STI) prevention13
, fertility awareness methods14
[including the
lactational amenorrhoea method (LAM)], and male and female sterilisation15
is available on
the FSRH website. The GDG considered the sections on these methods in the UKMEC as not
particularly helpful and so agreed to remove them.
Conditions No Longer Included
The following conditions are no longer included in the UKMEC:
Schistosomiasis and malaria: These infectious diseases are uncommon in the UK
population. Evidence suggests no contraindication to hormonal contraception use with both
conditions (UKMEC 1 for all methods in UKMEC 2009). Please refer to the WHOMEC1
if
required.
Raynaud’s disease/phenomenon: Expert opinion from UK rheumatologists was that the
UKMEC classification given in the UKMEC 2009 was unhelpful/no longer appropriate since
the risks associated with Raynaud’s disease relate to the underlying disease process rather
than the condition itself. Raynaud’s disease/phenomenon is therefore no longer included in
the UKMEC.

Drug interactions: Drug interactions are no longer presented at the end of each method
section since the recommendations quickly become outdated as new drugs become available.
Where appropriate to a specific condition (e.g. HIV infection or epilepsy), references to the
section on drug interactions with hormonal contraception and to relevant online drug interaction
checkers are made.
Inclusion of New Conditions
The new conditions added to the UKMEC include history of bariatric surgery, organ transplant,
cardiomyopathy, cardiac arrhythmias, rheumatoid arthritis, and positive antiphospholipid
antibodies.
The inclusion of these conditions into the UKMEC reflects increasing prevalence of women with
these conditions requesting contraception and the need of contraception providers for guidance.
Conditions for which there is a Revision of Sub-condition Description
Conditions where the sub-conditions have been revised include postpartum, gestational
trophoblastic disease, cervical cancer, HIV infection, and SLE.
Revisions to the sub-condition descriptions have been made to provide guidance that is more
specific/ relevant to the sub-population of women with each condition based on new evidence or
development of clinical practice/opinion.
Removal of Split Categories
As they were considered unhelpful, split categories (e.g. UKMEC 2/3 or 3/4) are no longer
used in the UKMEC for the following conditions: multiple risk factors for cardiovascular disease,
known dyslipidaemias, viral hepatitis (acute or flare) and diabetes (nephropathy/retinopathy/
neuropathy and other vascular disease).
Clarifications have been added or expanded upon to aid clinicians in their judgement regarding
whether a particular method of contraception is safe and appropriate for a woman.
Reordering of the Method Categories Presented in the UKMEC Tables
The order of contraceptive methods presented in the UKMEC has been changed to broadly
reflect (from left to right) long-acting, medium-acting and short-acting methods of contraception.
Inclusion of Ulipristal Acetate as New Method of Emergency Contraception
The UKMEC now includes ulipristal acetate (UPA) as a method of EC. The order of the methods
presented in the UKMEC table reflects the effectiveness of the method (from left to right): copper-
bearing IUD (Cu-IUD), UPA and levonorgestrel (LNG).
Changes to the UKMEC 2009 in the EC section include the addition of obesity as a new condition
(UKMEC 1 for all methods) and the expansion of the sub-conditions and UKMEC classification
recommendations for gestational trophoblastic disease (GTD).

09
PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
Breastfeeding
a) 0 to 6 weeks
See below
1 2 1 4
b) ≥6 weeks to 6 months
(primarily breastfeeding)
1 1 1 2
c) ≥6 months 1 1 1 1
Postpartum (in non-breastfeeding women)
a) 0 to 3 weeks
(i) With other risk factors for VTE
See below
1 2 1 4
(ii) Without other risk factors 1 2 1 3
b) 3 to 6 weeks
(i) With other risk factors for VTE
See below
1 2 1 3
(ii) Without other risk factors 1 1 1 2
c) ≥6 weeks 1 1 1 1
Postpartum (in breastfeeding or non
breastfeeding women, including post
caesarean section)
a) 0 to 48 hours 1 1
See above
b) 48 hours to 4 weeks 3 3
c) ≥4 weeks 1 1
d) Postpartum sepsis 4 4
SUMMARY OF CHANGES FROM UKMEC 2009
Conditions for which there has been a classification change for one or more methods or a major
modification to the condition description are highlighted. Conditions that do not appear below remain
unchanged.
Cu-IUD = Copper-bearing intrauterine device; LNG-IUS = Levonorgestrel-releasing intrauterine system; IMP = Progestogen-only implant; DMPA
= Progestogen-only injectable: depot medroxyprogesterone acetate; POP = Progestogen-only pill; CHC = Combined hormonal contraception
UKMEC Definition of category
Category 2 A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3 A condition where the theoretical or proven risks usually outweigh the advantages of using the method. The
provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since
use of the method is not usually recommended unless other more appropriate methods are not available or not
acceptable
CONDITION Cu-IUD LNG-
IUS
IMP DMPA POP CHC
I = Initiation, C = Continuation

History of bariatric surgery
a) With 30 kg/m2
BMI 1 1 1 1 1 1
b) With ≥30–34 kg/m2
BMI 1 1 1 1 1 2
c) With ≥35 kg/m2
BMI 1 1 1 1 1 3
Organ transplant
a)
Complicated: graft failure (acute or
chronic),
rejection, cardiac allograft vasculopathy
I C I C
2 2 2 3
3 2 3 2
b) Uncomplicated 2 2 2 2 2 2
CARDIOVASCULAR DISEASE (CVD)
Multiple risk factors for cardiovascular
disease (such as smoking, diabetes,
hypertension, obesity and dyslipidaemias)
1 2 2 3 2 3
Known dyslipidaemias 1 2 2 2 2 2
Cardiomyopathy
a) Normal cardiac function 1 1 1 1 1 2
b) Impaired cardiac function 2 2 2 2 2 4
Cardiac arrhythmias
a) Atrial fibrillation 1 2 2 2 2 4
b) Known long QT syndrome I C I C
1 2 1 2
3 1 3 1
NEUROLOGICAL CONDITIONS
Idiopathic intracranial hypertension (IIH) 1 1 1 1 1 2
acceptable
IUS
IMP DMPA POP CHC

11
acceptable
IUS
IMP DMPA POP CHC
Epilepsy 1 1 1 1 1 1
Taking anti-epileptic drugs Certain anti-epileptic drugs have the potential to affect
the bioavailability of steroid hormones in hormonal
contraception. In addition, hormonal contraception may
affect the levels of certain antic-epileptic drugs with potential
adverse effects.
For up-to-date information on the potential drug interactions
between hormonal contraception and anti-epileptic drugs,
please refer to the online drug interaction checker available
on Stockley’s Interaction Checker website.11
BREAST AND REPRODUCTIVE TRACT CONDITIONS
Gestational trophoblastic disease (GTD)
a) Undetectable hCG levels 1 1 1 1 1 1
b) Decreasing hCG levels 3 3 1 1 1 1
c) Persistently elevated hCG levels or
malignant disease
4 4 1 1 1 1
Cervical cancer
a) Awaiting treatment I C I C
2 2 1 2
4 2 4 2
b) Radical trachelectomy 3 3 2 2 1 2
Breast conditions
a) Undiagnosed mass/breast symptoms
1 2 2 2 2
I C
3 2
b) Benign breast conditions 1 1 1 1 1 1
c) Family history of breast cancer 1 1 1 1 1 1
d) Carriers of known gene mutations
associated with breast cancer (e.g.
BRCA1/BRCA2)
1 2 2 2 2 3
e) Breast cancer
(i) Current breast cancer 1 4 4 4 4 4
(ii) Past breast cancer 1 3 3 3 3 3

Ovarian cancer 1 1 1 1 1 1
acceptable
IUS
IMP DMPA POP CHC
Sexually transmitted infections (STIs)
a) Chlamydial infection (current) I C I C
(i) Symptomatic 4 2 4 2 1 1 1 1
(ii) Asymptomatic 3 2 3 2 1 1 1 1
b) Purulent cervicitis or gonorrhoea (current) 4 2 4 2 1 1 1 1
c) Other current STIs (excluding HIV and hepatitis) 2 2 1 1 1 1
d) Vaginitis (including Trichomonas vaginalis
and bacterial vaginosis) (current)
2 2 1 1 1 1
e) Increased risk for STIs 2 2 1 1 1 1
HIV INFECTION
HIV Infection
a) High risk of HIV infection 1 1 1 1 1 1
b) HIV infected
(i) CD4 count ≥200 cells/mm3
2 2 1 1 1 1
(ii) CD4 count 200 cells/mm3
I C I C 1 1 1 1
3 2 3 2
c) Taking antiretroviral (ARV) drugs Certain ARV drugs have the potential to affect the bioavailability of
steroid hormones in hormonal contraception.
For up-to-date information on the potential drug interactions
between hormonal contraception and ARV drugs, please refer to the
online HIV drugs interaction checker.10

13
acceptable
IUS
IMP DMPA POP CHC
ENDOCRINE CONDITIONS
Diabetes
a) History of gestational disease 1 1 1 1 1 1
b) Non-vascular disease
(i) Non-insulin dependent 1 2 2 2 2 2
(ii) Insulin-dependent 1 2 2 2 2 2
c) Nephropathy/retinopathy/neuropathy 1 2 2 2 2 3
d) Other vascular disease 1 2 2 2 2 3
Viral hepatitis
a) Acute or flare
1 1 1 1 1
I C
3 2
b) Carrier 1 1 1 1 1 1
c) Chronic 1 1 1 1 1 1
RHEUMATIC DISEASES
Rheumatoid arthritis 1 2 2 2 2 2
Systemic lupus erythematosus (SLE)
a) No antiphospholipid antibodies 1 2 2 2 2 2
b) Positive antiphospholipid antibodies 1 2 2 2 2 4
Positive antiphospholipid antibodies 1 2 2 2 2 4
DRUG INTERACTIONS
Taking medication See section on drug interactions with hormonal contraception.

SECTION B: METHODS OF CONTRACEPTION
Intrauterine Contraception (IUC).................................................................................15
Progestogen-only Contraception (POC)..................................................................... 38
Combined Hormonal Contraception (CHC).................................................................62
Emergency Contraception (EC)...................................................................................85
Summary Table for Hormonal and Intrauterine Contraception.....................................91

15
INTRAUTERINE CONTRACEPTION (IUC)
Intrauterine contraception (IUC) is highly effective and long-acting. The licensed duration of
use of IUC ranges from 3 to 10 years. IUC is significantly more cost effective than shorter-
acting methods due to very low failure rates and requirement for very minimal action by the
user apart from undergoing the initial insertion procedure.
IUC comprises two types:
• Copper-bearing intrauterine device (Cu-IUD)
• Levonorgestrel-releasing intrauterine system (LNG-IUS).
FSRH guidance on IUC1
is available on the FSRH website.
Copper-bearing intrauterine device (Cu-IUD)
Cu-IUDs have copper on their central stems and may also be banded with copper sleeves on
the arms. The surface area from which copper is released varies between devices. In general,
banded Cu-IUDs which have the higher surface areas of copper are the most effective and
long-lasting so are recommended as the first-choice copper devices.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
Several LNG-IUS devices are now available with two dosages of LNG. The 13.5 mg LNG-IUS
(releasing 6 µg LNG/day) is licensed for 3 years and the 52 mg LNG-IUS (releasing 20 µg
LNG/day) for 5 years. Although there are significantly more data for the 52 mg LNG-IUS, the
categories within the UKMEC can be extrapolated to the 13.5 mg LNG-IUS.

Pregnancy NA NA Clarification: Most pregnancies which occur
in women using IUC will be intrauterine, but
ectopic pregnancy must be excluded.
Women who become pregnant whilst using
IUC should be informed of the increased
risks of second-trimester septic miscarriage,
preterm delivery and infection if the IUC is left
in situ. Women who are pregnant with IUC in
situ and wish to continue with the pregnancy
should be informed that, when possible,
IUC removal reduces the risk of an adverse
outcome. However, removal itself carries
a small risk of miscarriage. Whether or not
IUC is removed, pregnant women should be
advised to seek medical care if they develop
heavy bleeding, cramping pain, abnormal
vaginal discharge or fever.1
Age
a) Menarche to 20 years 2 2 Evidence: Risks of pregnancy, infection and
perforation are low among IUC users of all
ages. Removals for bleeding issues do not
appear to be related to age. Younger women
using IUC may have an increased risk of
expulsion compared with older women.2–18
b) ≥20 years 1 1
Parity
a) Nulliparous 1 1 Evidence: Risks for expulsion, perforation,
pregnancy and infection are low among all
IUC users and differences by parity may not
be clinically meaningful. Data do not suggest
an increased delay in return to fertility for
nulliparous IUC users.2,4,8–11
b) Parous 1 1
acceptable
Intrauterine Contraception (IUC)
Copper-bearing IUD (Cu-IUD)
Levonorgestrel-releasing IUS (LNG-IUS)
IUC does not protect against STI/HIV. If there is a risk of STI/HIV
(including during pregnancy or postpartum), the correct and consistent
use of condoms is recommended, either alone or with another method
of contraception. Male condoms reduce the risk of STI/HIV.
CONDITION
*See additional comments at end of
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

17
Postpartum (in breastfeeding or non-
breastfeeding women, including post-
caesarean section)
a) 0 to 48 hours 1 1 Evidence: A systematic review concludes
that insertion of an IUC within the first 48
hours of vaginal or caesarean delivery is
safe. Post-placental insertion and insertion
between 10 minutes and 48 hours after
delivery result in higher expulsion rates than
insertion 4–6 weeks postpartum or non-
postpartum insertion. Insertion at the time of
a caesarean section is associated with lower
expulsion rate than post-placental insertion at
the time of vaginal delivery.19
There are limited data on insertion between
48 hours and 4 weeks. Three cohort
studies20–22
of poor to fair quality compare
outcomes of post-placental Cu-IUD insertion
with insertion between 10 minutes and 72
hours after delivery. The studies show a wide
range of expulsion rates; one study reports
an expulsion rate of 70%.22
The rate of uterine perforation associated
with IUC use is very low. The most important
risk factors for uterine perforation are
insertion during lactation and insertion in the
36 weeks after giving birth.23
The majority of studies show no significant
differences in breastfeeding outcomes in
women using LNG-IUS with insertion either
immediately postpartum or after 4 weeks.24–30
b) 48 hours to 4 weeks 3 3
c) ≥4 weeks 1 1
d) Postpartum sepsis 4 4 Clarification: Immediate insertion of an IUC
may substantially worsen the condition.
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

Post-abortion
a) First trimester 1 1 Evidence: IUC can be inserted immediately
after first- or second-trimester, surgical or
medical abortion.31
Evidence: There is no difference in risk of
complications for immediate versus delayed
insertion of an IUC after abortion. Expulsion
may be greater when an IUC is inserted
following a second-trimester abortion versus
following a first-trimester abortion.31–50
b) Second trimester 2 2
c) Post-abortion sepsis 4 4 Clarification: Immediate insertion of an IUC
may substantially worsen the condition.
Past ectopic pregnancy 1 1
History of pelvic surgery 1 1
Smoking Clarification: UKMEC currently does not include
use of e-cigarettes, as risks associated with their
use are not yet established.
Evidence: COC users who smoke are at an
increased risk of CVD, especially MI, compared
with those who do not smoke. Studies also show
an increased risk of MI with an increasing number
of cigarettes smoked per day.23–34
The 35 year age cut off is identified because
any excess mortality associated with smoking is
only apparent from this age.51
The mortality rate
from all causes (including cancers) decreases to
that of a non-smoker within 20 years of smoking
cessation. The cardiovascular disease (CVD) risk
associated with smoking decreases within 1 to 5
years of smoking cessation.51–53
a) Age 35 years 1 1
b) Age ≥35 years
(i) 15 cigarettes/day 1 1
(ii) 15 cigarettes/day 1 1
(iii) Stopped smoking 1 year 1 1
(iv) Stopped smoking ≥1 year 1 1
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

19
Obesity
a) BMI ≥30–34 kg/m2
1 1
b) BMI ≥35 kg/m2
1 1
a) With BMI 30 kg/m2
1 1
b) With BMI ≥30–34 kg/m2
1 1
c) With BMI ≥35 kg/m2
1 1
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS
Organ transplant
a) Complicated: graft failure (acute
or chronic), rejection, cardiac
allograft vasculopathy
I C I C Evidence: No comparative studies have
examined IUC use among transplant
patients. Four case reports of transplant
patients using IUC provide inconsistent
results, including beneficial effects and
contraceptive failures.54–57
3 2 3 2
b) Uncomplicated 2 2
CARDIOVASCULAR DISEASE
(CVD)
Multiple risk factors for CVD (such
as smoking, diabetes, hypertension,
obesity and dyslipidaemias)
1 2

Hypertension* Clarification: For all categories of
hypertension, classifications are based on
the assumption that no other risk factor for
CVD exists. When multiple risk factors do
exist, risk of CVD may increase substantially.
Vascular disease includes coronary heart
disease presenting with angina, peripheral
vascular disease presenting with intermittent
claudication, hypertensive retinopathy and
TIA.
a) Adequately controlled
hypertension
1 1
b) Consistently elevated blood
pressure (BP) levels (properly
taken measurements)
(i) Systolic 140–159 mmHg or
diastolic 90–99 mmHg
1 1
(ii) Systolic ≥160 mmHg or
diastolic ≥100 mmHg
1 1
c) Vascular disease 1 2
History of high BP during
pregnancy 1 1
Clarification: When current BP is
measurable and normal.
Current and history of ischaemic
heart disease*
1 I C Clarification: LNG-IUS may be continued
if women develop ischaemic heart disease
while using the method. Clinical judgement
and assessment of pregnancy risk and other
factors are required.
2 3
Stroke* [history of cerebrovascular
accident, including transient
ischaemic attack (TIA)]
1 I C
2 3
Known dyslipidaemias 1 2 Clarification: Routine screening for these
genetic mutations is not cost effective.
Increased levels of total cholesterol, low-
density lipoproteins (LDL) and triglycerides,
as well as decreased levels of high-density
lipoproteins (HDL), are known risk factors for
CVD. Women with known, severe, genetic
lipid disorders are at a much higher lifetime
risk for CVD and may warrant further clinical
consideration.
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

21
Venous thromboembolism (VTE)* Clarification: VTE includes deep vein
thrombosis (DVT) and pulmonary embolism
(PE) of any aetiology.
Evidence: Limited evidence indicates that
insertion of the LNG-IUS does not pose
major bleeding risks in women on long-term
anticoagulant therapy.58–60
Clarifications:
Major surgery: Includes major elective
surgery (30 minutes’ duration) and all
surgery on the legs, or surgery which
involves prolonged immobilisation of a lower
limb.61
Minor surgery: Includes operations
lasting 30 minutes with a short duration of
anaesthesia (e.g. laparoscopic sterilisation or
tooth extraction).61
a) History of VTE 1 2
b) Current VTE (on anticoagulants) 1 2
c) Family history of VTE
(i) First-degree relative
age 45 years
1 1
(ii) First-degree relative
age ≥45 years
1 1
d) Major surgery
(i) With prolonged
immobilisation
1 2
(ii) Without prolonged
immobilisation
1 1
e) Minor surgery without
immobilisation
1 1
f) Immobility (unrelated to surgery)
(e.g. wheelchair use, debilitating illness)
1 1
Superficial venous thrombosis
a) Varicose veins 1 1
b) Superficial venous thrombosis 1 1
Known thrombogenic mutations
(e.g. factor V Leiden, prothrombin
mutation, protein S, protein C and
antithrombin deficiencies)
1 2 Clarification: Routine screening for these
genetic mutations is not cost effective. 62–89
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

Valvular and congenital heart
disease
a) Uncomplicated 1 1 Clarification: Uncomplicated cases can be
considered where: there is (i) no requirement
for cardiac medication, (ii) the woman is
asymptomatic and (iii) a cardiology review
is required annually or less. If in doubt,
discussion with a specialist cardiologist is
advised.
Valvular heart disease: Occurs when any
of the heart valves are stenotic and/or
incompetent (e.g. aortic stenosis, mitral
regurgitation, tricuspid valve abnormalities,
pulmonary stenosis).90
Congenital heart disease: Aortic stenosis,
atrial septal defects, atrioventricular septal
defect, cardiomyopathy (hypertrophic or
dilated), coarctation of the aorta, complex
transposition of the great arteries, Ebstein’s
anomaly; Eisenmenger syndrome, patent
ductus arteriosus, pulmonary atresia,
pulmonary stenosis, tetralogy of Fallot, total
anomalous pulmonary venous connection,
tricuspid atresia, truncus arteriosus,
ventricular septal defect.90
Prophylaxis against bacterial endocarditis is
no longer indicated for women with artificial
heart valves or previous endocarditis when
inserting or removing IUC.91,92
However, this
does not necessarily mean that there is no
risk.1
b) Complicated (e.g. pulmonary
hypertension, history of subacute
bacterial endocarditis)
2 2
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

23
Cardiomyopathy
a) Normal cardiac function 1 1 Clarification: A woman who is not on cardiac
medication can be considered as having
normal cardiac function.
b) Impaired cardiac function 2 2 Evidence: No direct evidence exists on
the safety of IUC among women with
cardiomyopathy. Limited indirect evidence
from non-comparative studies does not
demonstrate any cases of arrhythmia or
infective endocarditis in women with cardiac
disease who used IUC.93,94
Clarification: IUC insertion may induce
cardiac arrhythmias in women with
cardiomyopathy. The IUC should be fitted
in a hospital setting as a vasovagal reaction
presents a particularly high risk of cardiac
events.91
Cardiac arrhythmias
a) Atrial fibrillation 1 2
b) Known long QT syndrome I C I C Clarification: Cervical stimulation during the
insertion of intrauterine methods can cause
a vasovagal reaction including bradycardia,
which increases the risk of a cardiac event
in women with long QT syndrome. The
IUC should be fitted in a hospital setting if
vasovagal reaction presents a particularly
high risk of cardiac events.91
3 1 3 1
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

NEUROLOGICAL CONDITIONS
Headaches
a) Non-migrainous (mild or
severe)
1 1 Clarification: Headache is a common
condition affecting women of reproductive
age. There is no identified evidence which
specifically considers migraine in women
using an LNG-IUS.
Classification depends on making an
accurate diagnosis of those severe
headaches that are migrainous and, in
addition, those complicated by aura.95–97
See additional resource on diagnosis of
migraines with or without aura.
b) Migraine without aura, at any
age
1 2
c) Migraine with aura, at any age 1 2
d) History (≥5 years ago) of
migraine with aura, any age
1 2
Idiopathic intracranial
hypertension (IIH)
1 1
Epilepsy 1 1
Taking anti-epileptic drugs Certain anti-epileptic drugs have the potential to affect the bioavailability
of steroid hormones in hormonal contraception. Additionally, hormonal
contraception may affect the levels of certain anti-epileptic drugs with
potential adverse effects.
For up-to-date information on the potential drug interactions between
hormonal contraception and anti-epileptic drugs, please refer to the
online drug interaction checker available on Stockley’s Interaction
Checker website.98
DEPRESSIVE DISORDERS
Depressive disorders 1 1 Clarification: The classification is based on
data for women with selected depressive
disorders. No data are available on bipolar
disorder or postpartum depression.
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

25
BREAST AND REPRODUCTIVE TRACT CONDITIONS
Vaginal bleeding patterns*
a) Irregular pattern without heavy
bleeding
1 1 Clarification: Abnormal menstrual bleeding
should raise suspicion of a serious
underlying condition and be investigated
appropriately.99–102
Evidence: Evidence from studies examining
the treatment effects of the 52 mg LNG-IUS
among women with heavy or prolonged
bleeding report no increase in adverse
effects and finds the 52 mg LNG-IUS
beneficial in treating heavy menstrual
bleeding (HMB).103–110
b) Heavy or prolonged bleeding
(includes regular and irregular
patterns)
2 I C
1 2
Unexplained vaginal bleeding
(suspicious for serious condition)
before evaluation
I C I C Clarification: If pregnancy or an underlying
pathological condition (such as pelvic
malignancy) is suspected, it must be
evaluated and the category adjusted
accordingly. The IUC does not need to be
removed before evaluation.
4 2 4 2
Endometriosis* 2 1 Evidence: 52 mg LNG-IUS use among
women with endometriosis decreases
dysmenorrhoea, pelvic pain and
dyspareunia.111–115
Benign ovarian tumours
(including cysts)
1 1
Severe dysmenorrhoea* 2 1
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

Gestational trophoblastic disease
(GTD)*
Clarification: Includes hydatidiform mole
(complete and partial) and gestational
trophoblastic neoplasia.
Evidence: Limited evidence suggests that
women using an IUC after uterine evacuation
for a molar pregnancy are at no greater
risk for gestational trophoblastic neoplasia
than are women using other methods of
contraception.116–119
a) Undetectable hCG levels 1 1
b) Decreasing hCG levels 3 3
c) Persistently elevated hCG levels
or malignant disease
4 4
Cervical ectropion 1 1
Cervical intraepithelial neoplasia
(CIN)*
1 2
Cervical cancer*
a) Awaiting treatment I C I C Clarification: Concern exists about the
increased risk of infection and bleeding at
insertion. The IUC will normally be removed
at the time of surgery, but until then the
woman is at risk of pregnancy.
4 2 4 2
b) Radical trachelectomy 3 3 Clarification: Insertion of IUC should be
conducted with caution in a specialist setting
due to abnormal anatomy.
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

27
Breast conditions
a) Undiagnosed mass/breast
symptoms
1 2 Clarification: Breast cancer is a hormonally
sensitive tumour. Concerns about
progression of the disease may be less with
LNG-IUS than with COC or higher-dose
POC.
Use of the LNG-IUS in women with breast
cancer for gynaecological reasons can
be considered on an individual basis in
consultation with the woman’s oncology
team.1
b) Benign breast conditions 1 1
c) Family history of breast cancer 1 1
d) Carriers of known gene mutations
associated with breast cancer (e.g.
BRCA1/BRCA2)
1 2
e) Breast cancer
(i) Current breast cancer 1 4
(ii) Past breast cancer 1 3
Endometrial cancer* I C I C
4 2 4 2
Ovarian cancer* 1 1
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS
Uterine fibroids
a) Without distortion of the uterine cavity 1 1 Evidence: Among women with uterine
fibroids, evidence shows no adverse health
events with 52 mg LNG-IUS use and a
decrease in symptoms and size of fibroid.
Most women experience improvements in
serum levels of haemoglobin, haematocrit,
ferritin and menstrual blood loss.120–131

b) With distortion of the uterine cavity 3 3 Clarification: In women with a distorted
uterine cavity it may be appropriate to
attempt insertion of IUC after discussion.
Evidence: Available studies show that rates
of 52 mg LNG-IUS expulsion are higher in
women with uterine fibroids than in women
without fibroids; however, these findings
are either not statistically significant or
significance testing was not conducted.129,
132
Rates of expulsion from non-comparative
studies ranged from 0% to 20%.126–131
Anatomical abnormalities
a) Distorted uterine cavity 3 3 Clarification: Includes any congenital or
acquired uterine abnormality distorting
the uterine cavity in a manner that is
incompatible with IUC insertion.
In some women with a distorted uterine
cavity it may be appropriate to attempt
insertion of IUC after discussion.
b) Other abnormalities 2 2 Clarification: Includes cervical stenosis or
cervical lacerations not distorting the uterine
cavity or interfering with IUC insertion.
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

29
Pelvic inflammatory disease (PID)
a) PID (assuming no current risk
factors for STIs)
1 1 Clarification:
Initiation: For routine IUC insertion,
women with symptomatic pelvic infection
should be tested for and treated. Insertion
should be delayed until symptoms have
resolved. Appropriate provision of alternative
contraception should be provided until the
IUC can be inserted.1
Continuation: For women with symptomatic
pelvic infection, treat using appropriate
antibiotics and perform testing for STIs.
There is usually no need to remove the IUC
if the woman wishes to continue its use.1
Continued use of an IUC depends on the
woman’s informed choice and her current
risk factors for STIs and PID. Among IUC
users treated for PID, there is no difference in
clinical course if the IUC is removed or left in
place.133–135
b) Current PID I C I C
4 2 4 2
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

Sexually transmitted infections
(STIs)
Clarification for chlamydia: In a woman
with asymptomatic infection in an emergency
situation (i.e. EC), the IUC can be inserted
without delay on the same day as treatment
is instituted.1
Clarification for Initiation: Screening for
STIs in advance of insertion (when indicated
or requested) will allow infection to be treated
before insertion. If results are unavailable
before insertion then prophylactic antibiotics
should be considered for women at higher
risk of STIs at time of insertion. The antibiotic
regimen chosen should cover Chlamydia
trachomatis.
Clarification for continuation: Treat the STI
using appropriate antibiotics. The IUC usually
does not need to be removed if the woman
wishes to continue using it. Continued use
of an IUC depends on the woman’s informed
choice and her current risk factors for STIs
and PID.1
Evidence: There is no evidence whether
IUC insertion among women who contract
STIs increases the risk for PID over that of
women with no IUC insertion. Among women
who have IUC inserted, the absolute risk for
subsequent PID is low among women with an
STI at the time of insertion but greater than
among women with no STI at the time of IUC
insertion.136–145
a) Chlamydial infection (current) I C I C
(i) Symptomatic 4 2 4 2
(ii) Asymptomatic 3 2 3 2
b) Purulent cervicitis or gonorrhoea
(current)
4 2 4 2
c) Other current STIs (excluding HIV
and hepatitis)
2 2
d) Vaginitis (including Trichomonas
vaginalis and bacterial vaginosis)
(current)
2 2
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

31
e) Increased risk for STIs 2 2 Clarification: IUC insertion may further
increase the risk of PID among women at
increased risk of STIs, although limited
evidence suggests that this risk is low. Risk
of STIs varies by individual behaviour and
local STI prevalence. Therefore, while many
women at increased risk of STIs can have
IUC inserted, some women at very high risk
of STIs may be advised to wait appropriate
testing and treatment occur.
Evidence: One small study shows a low
incidence of PID after IUC insertion (2.2%)
in a cohort of women considered to be
high risk.137
Another study reports that
11% of women classed as at high STI risk
experienced IUC-related complications
compared with 5% of those not classified as
high risk.141
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS
HIV INFECTION
HIV infection*
a) High risk of HIV infection 1 1 Evidence: High-quality evidence from one
randomised controlled trial observed no
statistically significant differences in HIV
acquisition between: DMPA-IM versus Cu-IUD,
DMPA-IM versus LNG implant, and Cu-IUD
versus LNG implant. Of the low-to-moderate-
quality evidence from 14 observational studies,
some studies suggested a possible increased
risk of HIV with progestogen-only injectable use,
which was most likely due to unmeasured
confounding. Low-quality evidence from 3
observational studies did not suggest an
increased HIV risk for implant users. No studies
of sufficient quality were identified for POP or
etonogestrel implant.

(i) CD4 count ≥200 cells/mm3
2 2 Clarification: The initiation of an IUC method
may be appropriate in some women with low
CD4 counts who have an undetectable viral
load.
Evidence: Among IUC users, limited
evidence shows no increased risk of
infection or overall complications when
comparing HIV-infected with non-infected
women. IUC use is not found to adversely
affect progression of HIV when compared
to hormonal contraception use among
HIV-infected women. IUC use among HIV-
infected women is not associated with
increased risk of transmission to sexual
partners.157–165
No difference is found in
antiretroviral therapy initiation or CD4 count
between users and non-users of the LNG-
IUS.166
(ii) CD4 count 200 cells/mm3
I C I C
3 2 3 2
c) Taking antiretroviral (ARV) drugs Certain ARV drugs have the potential to affect the bioavailability of
steroid hormones in hormonal contraception.
For up-to-date information on the potential drug interactions between
hormonal contraception and ARV drugs, please refer to the online HIV
drugs interaction checker.167
OTHER INFECTIONS
Tuberculosis*
a) Non-pelvic 1 1
b) Pelvic I C I C
4 3 4 3
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS
b) HIV infected

33
ENDOCRINE CONDITIONS
Diabetes
a) History of gestational disease 1 1
b) Non-vascular disease Evidence: Limited evidence on the use of
the LNG-IUS among women with insulin-
dependent or non-insulin-dependent diabetes
suggests that these methods have little
effect on short- or long-term diabetes control
(e.g. glycosylated haemoglobin levels),
haemostatic markers or lipid profile.168,169
(i) Non-insulin dependent 1 2
(ii) Insulin-dependent 1 2
c) Nephropathy/retinopathy/
neuropathy
1 2
d) Other vascular disease 1 2
Thyroid disorders
a) Simple goitre 1 1
b) Hyperthyroid 1 1
c) Hypothyroid 1 1
GASTROINTESTINAL CONDITIONS
Gallbladder disease
a) Symptomatic
(i) Treated by cholecystectomy 1 2
(ii) Medically treated 1 2
(iii) Current 1 2
b) Asymptomatic 1 2
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

History of cholestasis
a) Pregnancy related 1 1
b) Past-COC related 1 2
Viral hepatitis*
a) Acute or flare 1 1
b) Carrier 1 1
c) Chronic 1 1
Cirrhosis*
a) Mild (compensated without
complications)
1 1 Clarification: Severe (decompensated)
cirrhosis: development of major complications
(ascites, jaundice, encephalopathy or
gastrointestinal haemorrhage).170
b) Severe (decompensated) 1 3
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS
Liver tumours*
a) Benign
(i) Focal nodular hyperplasia 1 2
(ii) Hepatocellular adenoma 1 3
b) Malignant (hepatocellular
carcinoma)
1 3
Inflammatory bowel disease (IBD)*
(including Crohn’s Disease and
ulcerative colitis)
1 1
ANAEMIAS
Thalassaemia* 2 1
Sickle cell disease* 2 1

35
Iron deficiency anaemia* 2 1
RHEUMATIC DISEASES
Rheumatoid arthritis 1 2
Systemic lupus erythematosus
(SLE)
Clarification: People with SLE are at
increased risk of ischaemic heart disease,
stroke and VTE and this is reflected in the
categories given.
Available evidence indicates that many
women with SLE can be considered
good candidates for most methods
of contraception, including hormonal
contraception.171–189
a) No antiphospholipid antibodies 1 2
b) Positive antiphospholipid
antibodies
1 2
Positive antiphospholipid
antibodies
1 2 Clarification: Positive antiphospholipid
antibodies (aPL) is not itself a disease state
and in the absence of manifestations of the
antiphospholipid syndrome a stratification
of risk with specialist advice if necessary
is recommended. In particular, persistence
of aPL positivity, high titre of aPL, lupus
anticoagulant (LA) positivity, triple positivity
for anticardiolipin antibodies (aCL), anti-
β2-glycoprotein I (βgPI) and LA and
immunoglobulin G (IgG) aPL have greater
risk for future events.190–192
DRUG INTERACTIONS
Taking medication See section on drug interactions with hormonal contraception.
acceptable
CONDITION
section
CATEGORY
I = Initiation,
C = Continuation
Cu-IUD LNG-IUS

Additional Comments
HYPERTENSION, CURRENT AND HISTORY OF ISCHAEMIC HEART DISEASE, STROKE
There is theoretical concern about the effect of LNG on lipids. There is no restriction for Cu-
IUD.
VENOUS THROMBOEMBOLISM (VTE)
The LNG-IUS may be a useful treatment for HMB in women on long-term anticoagulation
therapy.
VAGINAL BLEEDING PATTERNS
LNG-IUS use frequently causes changes in menstrual bleeding patterns. Over time, LNG-IUS
users are more likely than non-users to become amenorrhoeic particularly if they have a 52
mg LNG-IUS fitted. 52mg LNG-IUS are used as a treatment for HMB.
ENDOMETRIOSIS
Cu-IUD use may worsen dysmenorrhoea associated with the condition.
SEVERE DYSMENORRHOEA
Dysmenorrhoea may intensify with Cu-IUD use. LNG-IUS use has been associated with
reduction of dysmenorrhoea.
GESTATIONAL TROPHOBLASTIC DISEASE (GTD)
There is theoretical concern about increased risk of perforation in the presence of persistent
molar tissue.
CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN)
There is some theoretical concern that progestogens may enhance progression of CIN.
CERVICAL CANCER
Awaiting treatment: There is concern about the increased risk of infection and bleeding at
insertion. The IUC may need to be removed at the time of treatment but, until then, the woman
is at risk of pregnancy.
ENDOMETRIAL CANCER
There is concern about the increased risk of infection, perforation and bleeding at insertion.

37
The IUC may need to be removed at the time of treatment but, until then, the woman is at risk
of pregnancy.
OVARIAN CANCER
The IUD may need to be removed at the time of treatment but, until then, the woman is at risk
of pregnancy.
HIV INFECTION
Women with HIV infection often have co-morbidities that may influence their choice of
contraception.
TUBERCULOSIS
Pelvic: Insertion of an IUC may substantially worsen the condition.
VIRAL HEPATITIS AND CIRRHOSIS
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised.
LIVER TUMOURS
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised. No evidence is available regarding hormonal contraceptive use in
women with hepatocellular adenoma. COC use is associated with growth of hepatocellular
adenoma, but it is still unknown whether other hormonal contraceptives have similar effects.
INFLAMMATORY BOWEL DISEASE (IBD)
Risk of VTE may increase in women who are unwell, bed-bound or undergoing emergency or
major surgery and prolonged immobilisation. Under these circumstances the use of the Cu-
IUD or LNG-IUS is safe.
THALASSAEMIA, SICKLE CELL DISEASE, IRON-DEFICIENCY ANAEMIA
There is concern about an increased risk of blood loss with Cu-IUD. However, LNG-IUS is
generally associated with reduced blood loss.

Progestogen-only Contraception (POC)
The section on progestogen-only contraception (POC) includes the following methods:
• Progestogen-only implant (IMP)
• Progestogen-only injectable: depot medroxyprogesterone acetate (DMPA)
• Progestogen-only pill (POP).
FSRH guidance on the IMP,1
progestogen-only injectable2
and POP3
is available on the FSRH
website.
Progestogen-only implant (IMP)
The recommendations in the UKMEC refer to the single-rod implant containing 68 mg
etonogestrel licensed for 3 years of use in the UK. For women using LNG implants the
UKMEC categories are considered the same as for etonogestrel implants.
Progestogen-only injectables: depot medroxyprogesterone acetate (DMPA)
The recommendations in the UKMEC refer to DMPA given intramuscularly (IM) or
subcutaneously (SC) at 13-weekly intervals.2
The available evidence reviewed by the UKMEC GDG suggests that DMPA-SC and DMPA-
IM appear to be therapeutically equivalent with similar safety profiles when used by healthy
women. The GDG considers the evidence available for DMPA-IM to be applicable to
DMPA-SC and, therefore, DMPA-SC should have the same categories as DMPA-IM. This
is presented in the UKMEC tables as the method ‘DMPA’. For women using intramuscular
norethisterone enantate (NET-EN), which is not licensed in the UK for long-term
contraception, the UKMEC categories are considered the same as for DMPA.
There are theoretical concerns that higher doses of progestogen in injectables and longer
duration of action may be associated with increased risk compared to IMP and POP in some
conditions. The higher UKMEC classifications reflect this.

39
Progestogen-only pill (POP)
The recommendations in the UKMEC refer to the POP currently available in the UK which
contain either norethisterone (NET) 350 μg, LNG 30 μg or desogestrel (DSG) 75 μg.
Theoretically, the DSG pill may be expected to be more effective than traditional POP,
especially with typical use, because ovulation is suppressed more consistently and it has a
longer missed pill window.4

Pregnancy NA NA NA Clarification: There is no known harm
to the woman, the course of pregnancy
or the fetus if POC is accidentally used
during pregnancy.
Age
a) Menarche to 18 years 1 2 1 Clarification: A guideline from the
National Institute for Health and Care
Excellence (NICE) recommends that
women should be informed that use
of DMPA is associated with a small
reduction in bone mineral density
(BMD) but this usually recovers after
discontinuation. Evidence for any long-
term effects of DMPA on BMD in women
aged 18 years is lacking.5
Evidence on long-term fracture risk is
sparse but women choosing to continue
DMPA should be reviewed every 2 years
to assess individual situations and to
discuss the risks and benefits. Women
should be supported in their choice of
whether or not to continue.2
In women
aged 18 years, DMPA can be used as
a first-line option after consideration of
other methods.6
b) 18–45 years 1 1 1
c) 45 years 1 2 1
Parity
a) Nulliparous 1 1 1
b) Parous 1 1 1
acceptable
Progestogen-only injectable: depot
medroxyprogesterone acetate (DMPA)
POC do not protect against STI/HIV. If there is a risk of STI/HIV (including
during pregnancy or postpartum), the correct and consistent use of
condoms is recommended, either alone or with another contraception
method. Male condoms reduce the risk of STI/HIV.
CONDITION
section
CATEGORY
I = Initiation, C = Continuation CLARIFICATION/EVIDENCE
IMP DMPA POP

41
Postpartum (in breastfeeding women)
a) 0 to 6 weeks 1 2 1 Evidence: Direct evidence demonstrates
no harmful effect of POC on
breastfeeding performance7–54
and
generally demonstrates no harmful
effects on infant growth, health or
development.15,30,39,45
b) ≥6 weeks to 6 months
(primarily breastfeeding)
1 1 1
c) ≥6 months 1 1 1
acceptable
CONDITION
section
CATEGORY
IMP DMPA POP
Postpartum (in non-breastfeeding women)
a) 0 to 3 weeks Clarification: This includes any births,
including stillbirths from 24 weeks’
gestation.
Clarification: POC may be safely
used by non-breastfeeding women
immediately postpartum, although they
are not required for contraception until
Day 21.55,56
Clarification: Other risk factors for
VTE, such as immobility, transfusion
at delivery, BMI 30 kg/m2
, postpartum
haemorrhage, immediately post-
caesarean delivery, pre-eclampsia
or smoking may pose an additional
increased risk for VTE.
(i) With other risk factors for VTE 1 2 1
(ii) Without other risk factors 1 2 1
b) 3 to 6 weeks
(i) With other risk factors for VTE 1 2 1
(ii) Without other risk factors 1 1 1
c) ≥6 weeks 1 1 1
Post-abortion
a) First trimester 1 1 1 Clarification: Includes induced abortions
and spontaneous miscarriages 24
weeks’ gestation.
POC can be started immediately
following surgical abortion or medical
abortion.57
b) Second trimester 1 1 1
c) Post-abortion sepsis 1 1 1

Past ectopic pregnancy 1 1 1 Clarification: All POC reduce the risk of
pregnancy (intrauterine and extrauterine).
History of pelvic surgery 1 1 1
acceptable
CONDITION
section
CATEGORY
IMP DMPA POP
Smoking Clarification: UKMEC currently does
not include use of e-cigarettes, as risks
associated with their use are not yet
established.
POC do not appear to increase the risk of
CVD even in smokers.58–61
The mortality rate from all causes
(including cancers) decreases to that of
a non-smoker within 20 years of smoking
cessation. The CVD risk associated with
smoking decreases within 1 to 5 years of
smoking cessation.61-64
The 35 year age
cut-off is identified because any excess
mortality associated with smoking is only
apparent from this age.64
a) Age 35 years 1 1 1
b) Age ≥35 years
(i) 15 cigarettes/day 1 1 1
(ii) ≥15 cigarettes/day 1 1 1
(iii) Stopped smoking 1 year 1 1 1
(iv) Stopped smoking ≥1 year 1 1 1
Obesity
a) BMI ≥30–34 kg/m2
1 1 1 Evidence: Weight gain is common. Among
adult women, there is generally no association
between baseline weight and weight gain
among DMPA users compared with non-
users. Evidence is mixed for adolescent
DMPA users, with some studies observing
greater weight gain among obese women
compared with normal weight users, yet other
studies showing no association. Data on
other POC methods and weight issues are
limited.65–82
b) BMI ≥35 kg/m2
1 1 1

43
a) With BMI 30 kg/m2
1 1 1 Clarification: Bariatric surgical
procedures involving a malabsorptive
component have the potential to decrease
oral contraception effectiveness, perhaps
further decreased by postoperative
complications such as long-term
diarrhoea and/or vomiting.
Evidence: Limited evidence
demonstrates no substantial decrease in
effectiveness of oral contraception among
women who underwent laparoscopic
placement of an adjustable gastric band.83
Limited evidence demonstrates no
substantial decrease in effectiveness of
oral contraception among women who
undergo a biliopancreatic diversion;84
however, evidence from pharmacokinetic
studies suggests conflicting results of
oral contraception effectiveness among
women who undergo a jejuno-ileal
bypass.85,86
b) With BMI ≥30–34 kg/m2
1 1 1
c) With BMI ≥35 kg/m2
1 1 1
Organ transplant
a) Complicated: graft failure (acute
or chronic), rejection, cardiac
allograft vasculopathy
2 2 2
b) Uncomplicated 2 2 2
CARDIOVASCULAR DISEASE (CVD)
Multiple risk factors for CVD (such
as smoking, diabetes, hypertension,
obesity and dyslipidaemias)
2 3 2 Clarification: When multiple major
risk factors exist, the risk of CVD may
increase substantially.
acceptable
CONDITION
section
CATEGORY
IMP DMPA POP

Hypertension* For all categories of hypertension,
classifications are based on the
assumption that no other risk factor
for CVD exist. When multiple risk
factors do exist, risk of CVD may
increase substantially.
Clarification: Women adequately
treated for hypertension are at a
reduced risk of acute myocardial
infarction (MI) and stroke compared
with untreated hypertensive women.
Although there are no data, POC
users with adequately controlled and
monitored hypertension should be at
reduced risk of acute MI and stroke
compared with untreated hypertensive
POC users. Antihypertensive
therapy may be initiated when the
BP is consistently 160/100 mmHg or
greater.87
Evidence: Limited evidence suggests
that among women with hypertension,
those who used POP or DMPA have a
small increased risk of cardiovascular
events compared with women who do
not use these methods.58
a) Adequately controlled hypertension 1 2 1
b) Consistently elevated BP levels
(properly taken measurements)
(i) Systolic 140–159 mmHg or
diastolic 90–99 mmHg
1 1 1
(ii) Systolic ≥160 mmHg or
diastolic ≥100 mmHg
1 2 1
c) Vascular disease 2 3 2 Clarification: Vascular disease
includes: coronary heart disease
presenting with angina, peripheral
vascular disease presenting with
intermittent claudication, hypertensive
retinopathy and TIA.
acceptable
CONDITION
section
CATEGORY
IMP DMPA POP

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